Provider Demographics
NPI:1467096446
Name:THE HERITAGE AT SAGEWOOD OPERATING , LLC
Entity Type:Organization
Organization Name:THE HERITAGE AT SAGEWOOD OPERATING , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-398-8005
Mailing Address - Street 1:16934 FRANCES ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2397
Mailing Address - Country:US
Mailing Address - Phone:402-933-2561
Mailing Address - Fax:402-933-2673
Practice Address - Street 1:1920 SAGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1585
Practice Address - Country:US
Practice Address - Phone:308-398-8005
Practice Address - Fax:308-675-3325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility